{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:56:36Z","timestamp":1791464196009,"version":"4.3.4"},"reference-count":4,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,6,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Nontraumatic osteonecrosis of the femoral head (ONFH) can lead to major disability in patients of all ages. It presents at various levels of severity and can be either symptomatic or asymptomatic. There is a vast array of management strategies. Treatment is often subject to physician bias. Clinical practice guidelines that are broad-based, internationally developed, consensus-driven, and strictly evidence-based are needed. The aim of this guideline by the Association Research Circulation Osseous (ARCO) was to develop international evidence-based recommendations to assist physicians and patients in managing ONFH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>ARCO convened an international, multidisciplinary guideline panel that was balanced to minimize potential bias from conflicts of interest. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was utilized, including GRADE Evidence-to-Decision frameworks. The panel prioritized clinical questions, defined criteria for the systematic review of evidence, evaluated the statistical analysis, and, by consensus, approved recommendation statements, which were then subject to external review by content experts and stakeholders (a health policy-maker and a patient).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The panel agreed on 12 recommendations for the diagnosis, evaluation, and management of ONFH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Key recommendations of these guidelines require accurately staging ONFH and determining when pain may be due to ONFH. They establish principles for optimal decision-making by assessing the quality of evidence backing various treatments and identifying numerous areas for additional investigation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Relevance:<\/jats:title>\n                    <jats:p>This international evidence-based guideline provides standardized recommendations for the diagnosis and management of nontraumatic ONFH. It synthesizes all available evidence using GRADE methodology and offers practical, consensus-supported guidance for accurate staging, imaging selection, treatment decision-making, and the identification of patients who would benefit from joint-preserving interventions. The guideline supports clinicians in reducing practice variation, improving diagnostic accuracy, and optimizing treatment pathways for patients with ONFH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.25.01616","type":"journal-article","created":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T18:00:32Z","timestamp":1775844032000},"page":"903-906","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Nontraumatic Osteonecrosis of the Femoral Head: An International Evidence-Based Clinical Practice Guideline*"],"prefix":"10.2106","volume":"108","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6125-9671","authenticated-orcid":false,"given":"Edward Y.","family":"Cheng","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1569-6130","authenticated-orcid":false,"given":"Alireza","family":"Mirzaei","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1919-3717","authenticated-orcid":false,"given":"Stuart B.","family":"Goodman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Stanford University, Redwood City, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4285-4488","authenticated-orcid":false,"given":"Quanjun","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4303-5556","authenticated-orcid":false,"given":"Michael A.","family":"Mont","sequence":"additional","affiliation":[{"name":"Rubin Institute for Advanced Orthopedics, Sinai Hospital, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6135-5564","authenticated-orcid":false,"given":"Lynne C.","family":"Jones","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the ARCO Clinical Practice Guideline workgroup\u2020","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,10]]},"reference":[{"issue":"10","key":"bib1-20260619","doi-asserted-by":"crossref","first-page":"2729","DOI":"10.1016\/j.arth.2025.05.064","article-title":"Osteonecrosis: A More Appropriate Term than Avascular Necrosis-Pathophysiologic Rationale","volume":"40","author":"Cheng","year":"2025","journal-title":"J Arthroplasty."},{"key":"bib2-20260619","first-page":"371","article-title":"Diagnosis and Treatment of Femoral Head Osteonecrosis: A Protocol for Development of Evidence-Based Clinical Practice Guidelines","volume":"38","author":"Cheng","year":"2021","journal-title":"Surg Technol Int."},{"issue":"1","key":"bib3-20260619","first-page":"107","article-title":"Diagnosis and Treatment of Nontraumatic Osteonecrosis of the Femoral Head: A Systematic Review and Meta-Analyses for the ARCO Clinical Practice Guideline Development Workgroup","volume":"14","author":"Parikh","year":"2026","journal-title":"Med Sci."},{"issue":"3","key":"bib4-20260619","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1007\/s12178-015-9280-0","article-title":"A current review of core decompression in the treatment of osteonecrosis of the femoral head","volume":"8","author":"Pierce","year":"2015","journal-title":"Curr Rev Musculoskelet Med."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01616","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:43:27Z","timestamp":1787751807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.25.01616"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,10]]},"references-count":4,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.25.01616","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,10]]}}}